How can countries better cooperate to fight future pandemics and ensure that the poorest are treated fairly?
One hundred and ninety-four member countries of the United Nations health agency, the World Health Organization (WHO), are negotiating a new agreement that would encourage better preparedness in the event of pandemics.
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The head of the WHO, Dr. Tedros Adhanom Ghebreyesus, said that during the covid-19 pandemic, "vaccine apartheid" took place.
Developing countries had trouble getting vital vaccines, which were all snapped up by rich countries, while nearly seven million people died worldwide.
What is the Pandemic Agreement?
It will be a legally binding agreement, although the exact form it will take has not yet been agreed upon.
The WHO has established an intergovernmental negotiating body (INB) to lead negotiations on this and draw up a draft.
The body is geographically balanced with six representatives from Brazil, Egypt, Japan, the Netherlands, South Africa and Thailand leading the negotiations.
The deadline for them is May 27, 2024, to submit the agreement to the World Health Assembly, a gathering of health ministers.
The WHO already has binding regulations known as the International Health Regulations (2005), which define the obligations of countries when events of public health concern have the potential to cross national borders.
These include immediate notification to the WHO of a health emergency and measures related to trade and travel.
This regulation was adopted after the Sars epidemic in 2002/2003. and is still perceived as functional for regional epidemics such as Ebola, but inadequate for a global pandemic.
It is also under review in the negotiations on a global pandemic agreement.
Three main points of contention
The draft agreement claims it wants to offer fairness and equal access to diagnostics, vaccines, personal protective equipment and medicines.
"During the last pandemic, Africa was the last region to gain access to vaccines and found itself at the mercy of countries from the Global North," says Dr. Viroj Tangcharoensatien, vice president-elect of the INB from Thailand, which represents Southeast Asian countries.
He says that the countries of the "global north" and "global south" are divided by three key issues:
1. Intellectual property and sharing of knowledge necessary for making vaccines and medicines
2. Financing developing countries to prepare and respond to pandemics
3. Access to generic resources and sharing of benefits from their use
Patents for drugs
Piotr Kolczynski, an adviser on European Union health policy for the non-governmental organization Oxfam, says the negotiations have reached an impasse.
"There is no progress because of the hardline stance of the EU and the US," he says.
The EU and the US are home to some of the world's largest drug manufacturers.
"They say that intellectual property is the cornerstone of innovation in the pharmaceutical industry, yet they do not hesitate to take decisive steps to overcome patent barriers locally," he tells the BBC.
The US government allowed companies like Moderna to override virtually any patent they wanted during the covid pandemic, says Kolczynski.
Meanwhile, the EU is currently working on a major overhaul of its own pharmaceutical and patent legislation.
The European Commission, the executive branch of the EU, has proposed a mandatory licensing mechanism through which it could bridge the pharmaceutical patent in the entire bloc of 27 member states in the event of a future pandemic, he adds.
"They recognize that intellectual property rights can be a barrier, but they oppose measures to bridge it for the Global South," said Kolczynski, who also represents the People's Alliance for Vaccines, a global network of more than 100 groups and networks.
"These are the double standards of the rich countries and they are hypocritical."
The European Commission says it still has "significant objections" although the draft text has improved in some areas.
"We have proven our own commitment with our ambitious initiative for regional and local vaccine production centers in Africa for Africa, but also by expanding to South America and Asia," said a spokesperson for the European Commission in a statement.
The spokesperson adds that the EU and its member countries are "in the first place" as donors to the World Bank's Pandemic Fund.
However, a senior source involved in the WHO negotiations says the reason for the lack of progress is not the divisions between the "global north" and the "global south".
"China and India are also big players. What are they? Are they north, south or east?" he says.
"There are many Western companies that are ready to get involved if their competitors like China do the same."
Both China and India are part of a 29-member group called the "Equality Group" at the talks.
Its other members are Brazil, Egypt, Thailand and Indonesia.
They say the needs of developing countries must be prioritized, while India also called for a "clear definition" of the role of developed countries.
Sharing data on pathogens
According to existing rules, countries must notify the WHO and share data on outbreaks.
Dr. Tangcharoensatien says data on pathogens and the disease's genetic sequence are key to developing testing equipment and vaccines to combat it.
They are given "for free" to the "pharmaceutical industry, which makes money from them," he adds.
The United Nations Convention on Biological Diversity (1992) and its Nagoya Protocol (2012) on access and benefit-sharing recognize the sovereignty of countries over genetic resources, with no legal obligation to share them, even in a state of public health emergency.
"Industries get free access to genetic sequencing information even though it is a country's resource, according to the Nagoya Protocol," Dr. Tangcharoensatien told the BBC.
However, the main lobby group for the drug industry, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), rejects this link.
She says the immediate sharing of pathogenic data on SARS-CoV-2 was key to the unprecedented speed of the response to Covid, where an effective vaccine was developed in a record 236 days.
"In general, conditions or negotiations related to the sharing of pathogen data risk causing significant delays in the development of medical countermeasures and could lead to serious consequences for public health," the statement said.
A precedent for the flu
Dr. Tangcharoensatien says that rich countries should make an annual financial contribution and provide pandemic products to countries with lower incomes.
There is a precedent.
Currently, pharmaceutical manufacturers make an annual contribution of $28 million to the WHO under a framework called Pandemic Influenza Preparedness (PIP).
The money is earmarked for capacity building and response activities during the pandemic.
WHO has real-time access to approximately 10 percent of the world's vaccine production so that it can send vaccines to developing countries that urgently need them.
She wants to apply the same mechanism to future pandemics.
The current draft proposes that WHO gain real-time access to 20 percent of pandemic products -- which include diagnostics, vaccines, personal protective equipment and therapeutics -- to allow for equitable distribution.
"We propose 10 percent as a donation and 10 percent at an affordable price so that the WHO can give it to countries with lower incomes," says Dr. Tangcharoensatien.
"This way, all countries - whether rich or poor - have access to the same vaccines at the same time."
However, a senior source involved in the negotiations said it was unlikely that rich countries would agree to "give up" vaccines in the midst of a pandemic.
"The EU, the USA and Great Britain believe that their politicians are not ready to say that they will commit to giving 10 percent, 15 percent, or whatever percentage is defined," he says.
With an agreement or without an agreement?
For people living in developing countries where healthcare is already limited, a pandemic agreement is much needed.
Agrej Aluso is the Africa director of the Pandemic Action Network, a group of 350 individuals and civil society groups campaigning for better preparedness in developing countries for infectious disease outbreaks.
“How do we move away from this status quo?” he asks.
"We have some parts of the world that have almost nothing to protect them from the pandemic."
A senior source involved in the WHO negotiations says any deal is better than no deal.
"Maybe everything doesn't have to be perfect on the first day, but let's get going," he says.
"I think everyone is convinced that we should do it in May. It might not be perfect, but we can build from there."
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